Health policy landscape in 2019

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The new year will bring a different landscape to health policy thanks to the message voters sent on Election Day, when they voted in historic numbers for a renewed vigor on health care access.

Candidates at the state and federal level who pledged to protect health care access won big and measures were passed in three states that expand Medicaid coverage.

At the federal level, Democrats in the U.S. House of Representatives are emboldened by a mid-term election in which health care was the top issue that motivated voters and delivered them the majority.

That all means that when the new Congress convenes in January, the ominous threats over the past two years to slash Medicaid, repeal the Affordable Care Act (ACA), and defund women’s health services will be off the table, although the administration will continue to take action to undermine the ACA and health access, such as its proposal on public charge and the recent removal of information resources to help enroll Latinos in health coverage.

House Democratic leaders are putting a priority on legislation designed to protect health coverage for people with pre-existing conditions. While the scope of the legislation remains unclear, we can expect a vote early in the new year for the House to formally register its position in favor of the Affordable Care Act in Texas v United States. This is the lawsuit brought by the Texas Attorney General challenging the constitutionality of the ACA. If successful, the lawsuit would destroy the ACA and likely result in the elimination of coverage protections for those with pre-existing conditions.

We should also expect new House leaders to advance legislation that would strengthen the ACA’s consumer protections, roll back some of the administration’s actions to weaken the ACA, make coverage more affordable, and promote greater access to reproductive health. While these efforts could die in the Senate or on the president’s desk, the House may opt to pass such legislation in order to build a record, increase public awareness, and address the concerns of voters.

While single-payer health care legislation, such as Medicare for All, will probably be introduced, it seems unlikely that there will be enough support to bring it to the House Floor for a vote. But the efforts might open the door for consideration of alternatives, such as a Medicare buy-in option or other public option legislation that makes health coverage available to more people.

There are some issues on the legislative health care agenda that may be able to garner bipartisan support. They include lowering prescription drug prices, banning surprise out-of-network bills, and stabilizing the ACA’s health insurance marketplaces. Whether these proposals can go from bipartisan support to the passage and enactment of actual legislation remains to be seen.

Meanwhile, at the state level, Governor-elect Gavin Newsom has said that he would “push the envelope” in expanding access to health care. Expanding Medi-Cal eligibility to all low-income Californians, including undocumented immigrants, is high on the agenda for many health and immigration advocates. The governor-elect has pointed to his record as mayor of San Francisco in expanding access to basic health care services to all, regardless of immigration status. At the same time, he also indicated a strong interest in maintaining a prudent budget reserve.

What is different about health care following this recent election, is that there is a strong willingness at the get-go to talk about the options to get to universal coverage. The discussion is expected to be more about the how vs. the what, which is a very exciting prospect.

Other reforms at the state level that will likely be debated in the new year include ways to make existing health care more affordable and the costs more transparent.

Finally, we are hopeful that the conversation about our state’s approach to health will include the greater notion of health and not just health care, through a more comprehensive approach to prevention and the social determinants of health.